NAM is the official provider of online scientific reporting for the
8th International AIDS Society Conference on HIV Pathogenesis, Treatment
and Prevention (IAS 2015), which will take place in Vancouver, Canada,
19th-22nd July 2015.

Knowledge gaps, problems accessing services for MSM in several countries of eastern and south-eastern Europe

Knowledge of PEP poor across Europe

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A
substantial minority of men who have sex with men (MSM) in countries such as Cyprus, Serbia,
Lithuania, Ukraine and Hungary are not being reached by HIV prevention
programmes and have gaps in their factual understanding of HIV and its
prevention, according to a report from the European MSM Internet Survey.

Although
residents of countries with a higher level of social and economic development
generally had better access and knowledge, there were notable exceptions ­– respondents in Ireland had poorer knowledge and worse access to
HIV testing than in neighbouring countries. Men found it hard to get hold of condoms in
Spain.

In 2010, the
European MSM Internet Survey (EMIS) surveyed around 180,000 gay or other men
who have sex with men from all parts of the continent. The study’s report was
released last month and a series
of Aidsmap articles have described other findings from this unique survey.

Knowledge

Questions
were formulated not only to assess respondents’ knowledge but also to educate
them – they were presented with a series of true statements, and asked whether
they already had this information. The results may somewhat over-estimate
participants’ knowledge, but this bias should be consistent across all
questions and populations.

Some
statements were quite basic, and most would be seen by health educators as
essential information for men who have sex with men to possess (e.g. “You
cannot be confident about whether someone has HIV or not from their appearance”,
“Most sexually transmitted infections can be passed on more easily than HIV”.)
A few were a little more specific (e.g. “PEP should be started as soon as
possible after exposure, preferably within hours”).

Respondents
across Europe were more knowledgeable about HIV testing than other topics – on
average, they were already aware of 93% of the statements on testing. In
general, knowledge of HIV transmission was greater (81%) than knowledge of sexually
transmitted infections (65%). Knowledge of PEP was low in every country, with
an average of 30% already having the information provided.

Taking all
16 questions together, mean national scores ranged from 62 to 81%. There
appeared to be a west-east divide, with the countries that scored highest being the Netherlands, the United Kingdom, Switzerland, France and
Denmark (all 78% or above).

Turkey,
where virtually no prevention programmes for MSM exist, had particularly low
scores in all of the knowledge areas (62%). Also scoring low were Romania (67%),
Cyprus (65%), Latvia (66%) and Lithuania (63%).

But there
were exceptions to these regional trends. Poland, Croatia and Bosnia & Herzegovina
had higher scores than neighbouring or culturally similar countries. Ireland,
Finland and Greece had poorer scores than comparable countries.

Younger and
less educated men had somewhat poorer knowledge than others.

More
significantly, differences in overall knowledge were strongly correlated with
HIV status – respondents diagnosed with HIV had a mean knowledge score
of 87%, those who last tested negative scored 77% and those who had never been
tested for HIV scored 67%.

Access to services

Respondents
were asked a series of questions about their access to HIV testing, condoms and
prevention information.

Overall,
91% were confident of their ability to get tested for HIV if they wished to.
Scores were generally higher in western Europe (e.g. 97% in France), but less
so in Ireland (88%), Portugal (91%) and Germany (91%). The poorest scores were
in Turkey (73%), Cyprus (80%) and Serbia (80%).

In relation
to condoms, men were asked if they had had unprotected anal intercourse in the
past year solely because they did not
have a condom to hand.

This was
the case for 14% of respondents (i.e. 86% did not have a problem with condom
availability). Again, the most encouraging results came from countries in
western Europe or Scandinavia.

However 30%
and 20% of Norwegian and Spanish respondents respectively had had unprotected
sex because condoms were not available, suggesting that condom availability is
as serious a problem in these countries as it is in Turkey (32%), Macedonia
(28%), Moldova (25%), Serbia (23%), Cyprus (23%) or Romania (20%).

Slovenia,
the Czech Republic and Hungary had good scores for condom availability.

Finally,
the questionnaire asked about either calling a telephone helpline or having
received sexual health information that was specifically for men who have sex
with men. Overall, 79% had done so, with the best scores again in the west of
the continent, and poorer scores in countries of south-eastern Europe and the
ex-Soviet Union.

Whereas
information provision was poor in Russia, access to HIV testing and condoms was
relatively good there.

The
researchers found that there was a strong correlation between the average score
for access to services in a country, and the average prevention knowledge score
that had been recorded in that country (R2=0.70014). In other words,
countries which have accessible HIV prevention services have better informed
populations.

They also
looked at the services data in relation to the inequality-adjusted Human
Development Indicator. This is a score which the United Nations uses to rank
countries, and which takes into account life expectancy, years of education,
average income and income inequality.

They also
found a strong correlation between a country’s level of development and access
to services (R2=0.69104).

“Structural
interventions addressing economic, social and political inequalities should be
essential to efforts to improve knowledge related to HIV and coverage by prevention
programmes,” say the authors.

Individual level associations

The
researchers also looked at the individual characteristics of men who had poorer
access to services. In multivariable analysis (after controlling for age,
education and country of residence), the following results were all
statistically significant. Migrants from outside Europe and men with a
clandestine sexuality were less likely to be reached by prevention services:

Men born in southeast Asia
(adjusted odds ratio = 0.58)

Men born in Latin America or the
Caribbean (adjusted odds ratio = 0.63)

Men who did not have any friends who
also have sex with men (adjusted odds ratio = 0.82)

Men identifying as bisexual
(adjusted odds ratio = 0.88)

Men who used sex venues (adjusted
odds ratio = 0.87).

Conversely,
men who were out about their sexuality or who used gay social venues had better
access to services. “Consequently, reaching men beyond these groupings should
be a goal for future interventions,” say the authors.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.